Tareq Kass-Hout, MD

Michal Karlinski, Adam Kobayashi, Anna Czlonkowska, Robert Mikulik, Daniel Vaclavik, Miroslav Brozman, et al. Role of Preexisting Disability in Patients Treated With IntravenousThrombolysis for Ischemic Stroke. Stroke. 2014

Karlinski et al. conducted a retrospective data analysis recently published online in stroke, that is looking at the risk of symptomatic intracranial hemorrhage sICH post intravenous thrombolysis in patients with previous stroke-related disability. This study sheds a light on the impact of different levels of pre-stroke disability on patients’ profile and outcome after intravenous thrombolysis. This subgroup of patients is usually excluded from most stroke trials, which giv
es an extra value to this study.

Patients, a total of 7250, retrieved from the Safe Implementation of Thrombolysis for Stroke – Eastern Europe, with no pre-stroke disability (modified Rankin Scale [mRS] score 0) patients used as a reference in based on demographics and co-morbidities. Patients with pre-existing disability were divided in 3 groups based on their presentation mRS as 1,2, and ≥3. The analysis showed that thrombolysis in patients with pre-existing stroke-related stroke does not increase the risk of sICH. On the other hand, pre-existing stroke-related disability patients have an increased risk of death at 90 days and lower chance of achieving favorable outcomes.

In short, this study reinforcing that, even though patients who have pre-stroke disability had a higher mortality rate compared to patients with no previous disability, they had no increased risk of sICH.  In other words, these patients should not be routinely excluded from thrombolysis therapy.